| BackgroundWith the changes of aging population,urbanization and lifestyle,the prevalence of type 2 diabetes(T2DM)and osteoporosis(OP),which is a common complication of T2DM,has increased significantly.At the same time,these two kinds of disease is closely related.In recent years,various studies have shown that T2DM may not only cause osteoporosis,but also increase the risk of osteoporotic fractures,especially in postmenopausal women and men who are over 50 years.However,whether the patients diagnosed with primary osteoporosis or T2DM osteoporosis,will bring huge psychological pressure and economic burden once the fracture occurred.Therefore,early prevention,diagnosis and treatment of osteoporosis is essential.At present,the Dual energy X-ray absorptiometry(DXA)is used clinically to diagnose osteoporosis,curative effect evaluation and fracture prediction,especially in primary hospitals.Calcaneus quantitative ultrasound bone density(QUS),as a screening method for OP,is more popular in primary hospitals and physical examination institutions.It is small and easy to carry for community screening,which is conducive to the early diagnosis of OP.However,the T values measured by QUS and DXA are not comparable,because there is no unified QUS screening criterion all over the world.Whether the QUS result judgment of T2DM patients is different from the general population remains to be explored.ObjectiveIn this study,we aimed to explore the association between DXA and QUS application in measuring bone mineral density among different population(male,female,T2DM population)as well as the cut-off point of T value in different populations for screening high-risk groups of osteoporosis.Besides,in middle-aged and elderly type 2 diabetes patients,we also explored the association between QUS and other characteristics,such as body mass index,diabetes course,complications,treatment options,biochemical indicators and DXA parameters.Objects and methodsFrom May 2019 to January 2020,a total of 406 objects were recruited volunteers and medical examiners in Qilu Hospital of Shandong University(hereinafter referred to as the overall population,including 152 men and 254 women).124 middle-aged and elderly T2DM patients in the outpatients and inpatients of the department of endocrinology in Qilu Hospital of Shandong University(hereinafter referred to as the T2DM group,including 61 men over the age of 50 and 63 postmenopausal women).Besides,none of these 406 objects had used osteoporosis treatment drugs.In this study,we needed to collect the clinical characteristics and relevant medical history of all these 406 objects,we also needed to collect the disease course,complications,treatment plan and biochemical indicators among the T2DM group patients.Meanwhile,it is vital to collect the DXA(Hologic,Discovery-Wi type)to detect the bone density,T value,and Z value of all patients' total lumbar spine,femoral neck and total hip.Besides,calcaneus QUS(Hologic,Sahara-type)detected all patients' BUA,SOS,T value,Z value,bone density value,bone hardness value and other indicators are also needed.The overall population were divided into female group and male group at first,and then based on the results of DXA,the two groups were further divided into osteoporosis group,bone loss group and normal bone quantity group respectively.According to the different parameters measured by DXA,the male and female group are further divided into femoral neck group,total hip group and total lumbar spine group.Furthermore,all patients are divided into osteoporosis group,non-osteoporosis osteoporosis group,low bone mass group and normal group according to the diagnostic criteria recommended by the World Health Organization(WHO).Among the T2DM patients,they were divided into postmenopausal female group and male over 50 years group according to gender.Male and female T2DM patients are further divided into femoral neck group,total hip group and total lumbar spine group according to different detection sites.Finally,all patients were divided into osteoporosis group and non-osteoporosis group,low bone mass group and normal group according to the recommendation by WHO.Male and female T2DM patients were divided into osteoporosis group and non-osteoporosis group with DXA-T?-2.0.All data were presented as meaną standard deviation,median and interquartile range.Statistical analysis was performed using Pearson and Spearman correlation analysis,analysis of variance,LSD-t,Kruskal-Wallis,Mann-Whitney-U,chi-square test,Logistic regression and ROC curve analysis.Results1.The sensitivity and specificity of QUS in screening overall population osteoporosis and low bone mass,the best cut-off value of QUS-T under the ROC curve.The sensitivity of QUS for screening OP and low bone mass were 36.6%and 74.7%,and the specificity was 90.8%and 71.0%,respectively.ROC curve analysis showed that when AUC are 0.764,0.786,QUS screen OP and low bone mass T cutoff values are-1.7,-1.0,respectively.2.Correlation between QUS parameters and T value of each part of DXA,the sensitivity and specificity of QUS in screening overall population osteoporosis and low bone mass in different parts(femoral neck,total hip,and total lumbar spine),the best cut-off value of QUS-T under the ROC curve.QUS-bone hardness value,bone density value,BUA,SOS and T value are positively correlated with Femoral neck T value,total hip T value,Wards triangle T value,total lumbar T value,among which QUS-T has the highest correlation with Wards triangle T value and the lowest correlation with lumbar spine T value.The sensitivity of QUS in screening OP of femoral neck,total hip and total lumbar spine was 48.9%,76.2%and 34.7%,the specificity was 87.3%,86.5%and 89.2%,respectively.The sensitivity to screen low bone mass was 79.0%,81.1%,and 73.1%and the specificity was 63.8%,54.7%,and 63.9%,respectively.ROC curve analysis suggested that when the AUC of these three parts were 0.785,0.877 and 0.749,the T cutoff values of QUS screen OP are-1.8,-2.2 and-1.7,respectively.While the AUC were 0.794,0.773,and 0.740,the cutoff values for the screen low bone mass T values were-1.3,-1.7 and-1.1,respectively.3.Comparison of partial parameters in three subgroups(osteoporosis group,osteopenia group and normal bone mass group)based on the female and male group.Female group:Height,weight,OSTA indexes,QUS-bone hardness value,BMD,BUA,SOS,T values among three subgroups were gradually increased and menopause years gradually decreased.The age of osteoporosis group and osteopenia group was higher compared with normal bone mass group and BMI in osteoporosis group was lower than osteopenia group and normal bone mass group.Male group:Weight,BMI,and OSTA indexes of these three subgroups were gradually increased.The osteoporosis group patients is older than normal bone mass group.The QUS-bone hardness values,BMD,SOS and T values in osteopenia group were higher than normal bone mass group.4.QUS is used to screen osteoporosis and low bone mass,sensitivity and specificity,and the best cut-off value of QUS-T under the ROC curve.In the female group,the sensitivity of QUS screening OP and low bone mass were 42.7%and 80.4%,the specificity was 86.7%and 75.4%,respectively.ROC curve analysis indicated that when AUC is 0.779,0.843,QUS screening OP and low bone mass T cutoff values are-1.7,-1.0,respectively.In the male group,the sensitivity of QUS screening OP and low bone mass were 0%and 59.7%,and the specificity was 95.6%and 67.5%,respectively.ROC curve analysis indicated that when AUC is 0.664,T cutoff value of QUS screening low bone mass is-1.0.5.Correlation between QUS-T and DXA T value in female group and male group,QUS screening different parts(femoral neck,total hip,total lumbar spine)for osteoporosis and low bone mass,the sensitivity and specificity,the best cut-off value of QUS-T under the ROC curve.QUS-T was positively correlated with femoral neck T value,total hip T value,Wards triangle T value and total lumbar spine T value in two groups.In the female group,male group and the overall population,QUS-T and Wards triangle-T are the most correlated.Female group:the sensitivity of the QUS screening OP for three sites is 52.4%,76.2%and 41.2%,the specificity is 81.1%,80.3%and 84.0%,respectively.The sensitivity of screening low bone mass is 82.9%,87.0%and 79.5%,the specificity were 61.5%,49.3%and 61.4%,respectively.ROC curve analysis indicated when the AUC is 0.763,0.851 and 0.752,QUS cut-off value of QUS screening OP is-2.0,-2.5 and-1.7.When AUC is 0.828,0.804 and 0.794,screening low bone mass the cutoff values of T are-1.6,-1.8,and-1.3,respectively.Male group:The sensitivity of the QUS for screening OP at three sites is 0%,the specificity is 96.0%,96.0%and 95.6%;the sensitivity of screening low bone mass is 67.3%,65.0%,53.6%,the specificity was 66.0%,61.6%and 59.4%,respectively.ROC curve analysis demonstrated that when the AUC is 0.695 and 0.671,the low bone mass T cutoff values for femoral neck and total hip screening are-1.0 and-1.2.6.QUS screening the sensitivity,specificity of osteoporosis and low bone mass group,the best cutoff value of QUS-T under the ROC curve in the postmenopausal female T2DM group and male over 50 years old T2DM group.Postmenopausal female T2DM group:The sensitivity of QUS screening OP and low bone mass were 41.7%and 88.0%,the specificity was 89.7%and 46.2%.ROC curve analysis demonstrated that when AUC is 0.813 and 0.731,QUS screening OP and low bone mass T cutoff values are-1.7 and-1.5.Male over 50 years old T2DM group:The sensitivity of QUS screening OP and low bone mass were 0%and 67.6%,the specificity was 96,5%and 62.5%.ROC curve analysis showed that when AUC is 0.701,the cutoff value of QUS screening low bone mass is-1.1.7.When DXA-T?-2.0 was used as the standard for screening T2DM combined with OP,the optimal cutoff value of QUS under the ROC curve of OP in the postmenopausal female T2DM group and male over 50 years old T2DM group.In the postmenopausal female T2DM group,when T?-2.0 was used as the criterion for diagnosing OP,the sensitivity of OP screening by QUS method was 76.7%,the specificity was 75,8%.ROC curve analysis showed that when AUC is 0.769,the T cutoff value of QUS screening OP is-1.5.In the male over 50 years old T2DM group,the sensitivity of OP for QUS screening was 36.4%,the specificity was 86.0%.ROC curve analysis showed that when the AUC is 0.709,the T cutoff value of QUS screening OP is-1.3.8.Correlation between QUS-T and T value of each part of DXA in postmenopausal female T2DM group and male over 50 years old T2DM group,and screening for osteoporosis in different sites(femoral neck,total hip and total lumbar vertebrae)in two groups,sensitivity and specificity of low bone mass and the best cutoff value of QUS-T under the ROC curve.In the middle-aged and elderly T2DM populations,postmenopausal female T2DM group and male over 50 years old T2DM group,QUS-T was positively correlated with femoral neck T value,total hip T value,Wards triangle T value as well as total lumbar T value.Between the two groups,QUS-T had the highest correlation with total hip-T value and the lowest correlation with total lumbar spine T value.Postmenopausal female T2DM group:The sensitivity of the QUS method for screening OP of the femoral neck,total hip and total lumbar spine was 41.7%,100%and 45.0%,the specificity was 86.3%,86.0%and 88.4%.The sensitivity for screening low bone mass was 88.6%,96.0%and 88.9%,the specificity was 36.8%,28.9%,and 38.9%.ROC curve analysis suggested that when AUC is 0.853,0.961 and 0.776,T cut-off value of QUS screening OP is-2.1,-2.5 and-1.7.When the AUC was 0.751,0.846,and 0.746,the cut-off values of QUS screening for low bone mass T was-1.8,-1.9 and-1.5.Male over 50 years old T2DM group:the sensitivity of the QUS method for screening OP at three sites is 0%,the specificity is 96.7%,96.7%and 96.5%;while the sensitivity for screening low bone mass is 75.0%,80.0%and 69.6%,the specificity was 60.6%,56.1%and 52.6%,respectively.ROC curve analysis suggested that,when AUC is 0.746,0.777 and 0.679,T cut-off values for screening low bone mass are-1.3,-1.2 and-1.3.9.Correlation analysis among QUS parameters,basic data,biochemical indexes and bone mineral density parameters in middle-aged and elderly T2DM patients.QUS-bone hardness value and bone density value are positive related to height,weight,BMI,OSTA index,WC,WHR,ALB,UA,eGFR,RBC,Hb,DXA-BMD(femoral neck,total hip,Wards triangle,full lumbar spine),and have negative correlation with age,AKP,ESR.QUS-BUA is positive related to height,weight,BMI,OSTA index,WC,WHR,RBC,Hb,DXA-BMD(femoral neck,total hip,Wards triangle,full lumbar spine),while have negative correlation with AKP and ESR.QUS-SOS and height,weight,BMI,OSTA index,WC,WHR,ALB,UA,eGFR,RBC,Hb,DXA-BMD(femoral neck,total hip,Wards the triangle,the whole lumbar spine)were positively correlated,and negatively correlated with age,AKP,ESR and vascular disease of the lower extremities.QUS-T and height,weight,BMI,OSTA index,WC,WHR,ALB,eGFR,RBC,Hb,DXA-BMD(femoral neck,total hip,Wards Triangle,total lumbar spine)were positively correlated,and negatively correlated with age,vascular disease of lower extremities,AKP,UACR and ESR.10.Using QUS as the screening OP standard method,univariate and multivariate analysis of independent risk factors related to type 2 diabetic osteoporosis in the middle-aged and elderly.The course of disease,smoking history,and HbA1c are risk factors for DOP.Conclusion1.QUS method has high accuracy for screening low bone mass in male and female populations,and high accuracy for screening osteoporosis in the postmenopausal female type 2 diabetic populations.QUS can be used as an important tool for screening osteoporosis and low bone mass in different populations.2.QUS method has low accuracy in screening for osteoporosis in male patients with male over 50 years old type 2 diabetic populations.When DXA-T?-2 is used as the diagnostic criteria for DOP,the accuracy of screening is increased.3.QUS method has certain value for screening middle-aged and elderly T2DM osteoporosis and can be used as an early screening tool in areas lacking DXA. |
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